Inherited and Acquired Thrombophilia and Infertility

SummaryNo relevant deficiency of TFPI or genetic polymorphisms could thus far consistently be associated with venous thromboembolism. We hypothesized that the substrates of the TFPI protein, including FVII or FX (rather than the protein itself) could induce a hypercoagulable state. We created a novel TF-based clotting assay that evaluated the anticoagulant response to exogenously added recombinant TFPI. The response to TFPI was expressed as the ratio of the clotting time with and without TFPI. By using 118 healthy controls, we established a reference range between 1.31 and 1.93 (mean value ± 2 standard deviations (SD), 1.62 ± 0.31). We then evaluated samples from 120 patients with a history of venous thromboembolism but no evidence of hereditary and acquired thrombophilia. The range of the patients’ ratios was significantly (P < 0.001) lower, falling between 1.2 and 1.78 (mean value ± 2 SD, 1.49 ± 0.29). Of the 120 patients, 39 (32.5%) had a TFPI sensitivity ratio below the 10th percentile of the controls, compared with 11 (9.3%) of the healthy controls. The crude odds ratio for venous thrombosis for subjects with a TFPI sensitivity ratio below the 10th percentile was 13 (95% CI; range, 3.1 to 54.9) compared with those with a ratio above 1.8 (90th percentile). Patients with idiopathic thromboembolism did not have a decreased TFPI sensitivity ratio more often than patients with thrombosis with a circumstantial risk factor. Based on these results, a reduced response to TFPI may lead to an increased risk of venous thrombosis.

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Gestational Outcome in Thrombophilic Women with Recurrent Pregnancy Loss Treated by Enoxaparin

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613894 ◽

2000 ◽

Vol 83 (05) ◽

pp. 693-697 ◽

Cited By ~ 195

Author(s):

R. Hoffman ◽

Z. Blumenfeld ◽

Z. Weiner ◽

J. S. Younis ◽

B. Brenner

Keyword(s):

Molecular Weight ◽

Live Birth ◽

Antithrombotic Therapy ◽

Low Molecular Weight Heparin ◽

Pregnancy Loss ◽

Recurrent Pregnancy Loss ◽

Living Child ◽

Low Molecular Weight ◽

Single Living ◽

Acquired Thrombophilia

SummaryInherited and acquired thrombophilia are associated with recurrent pregnancy loss (RPL). We have evaluated the efficacy and safety of the low molecular weight heparin enoxaparin in 50 women, (mean age 26 ± 3 years) with RPL (>3 losses in 1st, >2 losses in 2nd and >1 loss in 3rd trimester) who were found to harbor thrombophilia. Twentyseven had a solitary thrombophilic defect, and twenty-three women had combined thrombophilic defects: 17 – two defects and 6 – three defects. Following diagnosis of thrombophilia, sixty-one subsequent pregnancies were treated with the low molecular weight heparin enoxaparin throughout gestation until 4 weeks after delivery. Dosage was 40 mg/day in women with solitary defect and 80 mg/day in combined defects. Aspirin, 75 mg daily was given in addition to enoxaparin to women with antiphospholipid syndrome. Forty-six out of 61 (75%) gestations treated by enoxaparin resulted in live birth compared to only 38/193 (20%) of the untreated pregnancies in these 50 women prior to diagnosis of thrombophilia (p <0.00001). In 23 women without a single living child following 82 untreated gestations, antithrombotic therapy resulted in 26/31 (84%) successful deliveries (p <0.0001). In 20 women with a prior living child, antithrombotic therapy improved successful delivery from 33/86 (38%) to 20/21 (95%) (p <0.0001). Enoxaparin dose of 40 mg/day resulted in live birth in 24/35 (69%) of gestations, compared to 19/23 (83%) gestations in women treated with 80 mg/day (p = 0.37). Only one thrombotic episode and one mildbleeding episode were noticed during enoxaparin therapy. Enoxaparin is safe and effective in prevention of pregnancy loss in women with inherited and acquired thrombophilia.

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Antiphospholipid Antibodies and Acquired Thrombophilia: A Biological Marker for Recurrent Miscarriage

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i52b33609 ◽

2021 ◽

pp. 137-143

Author(s):

Rania Khogli ELsidig Khogli ◽

Abdel Rahim Mahmoud Muddathir ◽

Alaa Eltayeb Omer ◽

Lienda Bashier Eltayeb

Keyword(s):

Partial Thromboplastin Time ◽

Antiphospholipid Antibodies ◽

Tissue Injury ◽

Recurrent Miscarriage ◽

Biological Marker ◽

Activated Partial Thromboplastin Time ◽

P Value ◽

Increased Risk ◽

The One ◽

Acquired Thrombophilia

Background: Repeated miscarriage can cause tissue injury can lead to the formation of antibodies to the phospholipids. Recurrent miscarriage (RM) is considering the one of the most common cause of sterility. Which has received more attention in recent years as a result of an increase in the number of reproductive-aged women. Materials and Methods: Plasma samples were tested for antiphospholipid antibodies using ELISA, and platelet count using Sysmex (KX21) Heamatology analyzer and Activated Partial Thromboplastin Time using semi-automated machine (STAGO PT31039352 (for coagulation). Results: The prevalence of Anti phospholipid antibodies (APL) was 30.5% in Sudanese patients with recurrent miscarriage, the prevalence of (Anti phospholipid Antibodies-IgM and IgG) was found to be 23.6% in patients with recurrent miscarriage compared to (Anti phospholipid Antibodies-IgG) was found to be 11.1% ((P value≤0.001), low platelets count (<50×109/l) observed in 10 (13.5%), as well as prolongation of activated partial thromboplastin time (APTT) among studied group were detected among 19 (26.1%). Conclusion: Higher prevalence of antiphospolidids antibodies, and acquired thrombophilia was detected among Sudanese women with recurrent abortion; The findings are concerning because they link an increased risk of thrombosis and a hypercoagulable state lead to recurrent miscarriage in pregnant women.

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Effects of multiple inherited and acquired thrombophilia on outcomes of in-vitro fertilization

Thrombosis Research ◽

10.1016/j.thromres.2018.05.006 ◽

2018 ◽

Vol 167 ◽

pp. 26-31 ◽

Cited By ~ 6

Author(s):

Marcello Di Nisio ◽

Adalisa Ponzano ◽

Gian Mario Tiboni ◽

Maria Domenica Guglielmi ◽

Anne Wilhelmina Saskia Rutjes ◽

...

Keyword(s):

In Vitro Fertilization ◽

Vitro Fertilization ◽

Acquired Thrombophilia

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Acquired Thrombophilia in Pregnancy

10.1007/978-3-030-83434-0_23 ◽

2021 ◽

pp. 427-435

Author(s):

André Luiz Malavasi ◽

Daniela Aires Moreira

Keyword(s):

Acquired Thrombophilia ◽

In Pregnancy

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How I treat rare venous thromboses

Blood ◽

10.1182/blood-2008-07-165969 ◽

2008 ◽

Vol 112 (13) ◽

pp. 4818-4823 ◽

Cited By ~ 37

Author(s):

Ida Martinelli ◽

Massimo Franchini ◽

Pier Mannuccio Mannucci

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Recent Progress ◽

Randomized Trials ◽

Lower Limbs ◽

Optimal Management ◽

Venous Diseases ◽

Acquired Thrombophilia ◽

Venous Thromboses

Abstract Venous thromboembolism may involve venous sites other than the lower limbs, such as cerebral, splanchnic, and upper limb veins. Although uncommon, these thromboses may be clinically severe and challenging for caregivers. In this review, the main pathogenic, clinical, and therapeutic features of thromboses in rare venous sites are discussed. Even though there was a lot of recent progress in understanding the mechanistic role of inherited and acquired thrombophilia and of the interactions between different risk factors, the optimal management of these patients is still unsettled, being currently based on the consensus of experts due to the lack of randomized trials. The implementation of large interdisciplinary registries is a necessary weapon to optimize the treatment of rare venous diseases.

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